Raw X12 — CIN ZF85153E

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2005*|*00501*565100738*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2005*100738*X*005010X279A1~ST*270*0738*005010X279A1~BHT*0022*13*202608122005000001*20260812*2005~HL*1**20*1~NM1*PR*2*NYSDOH*****PI*EMEDNY~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~PRV*PE*PXC*251B00000X~HL*3*2*22*0~TRN*1*202608122005000001*00000000ND~NM1*IL*1******MI*ZF85153E~EQ*30~DTP*291*D8*20260813~SE*13*0738~GE*1*100738~IEA*1*565100738~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1604*^*00501*533841530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160456*533841530*X*005010X279A1~ST*271*533841530*005010X279A1~BHT*0022*11*202608122005000001*20260812*160456~HL*1**20*1~NM1*PR*2*NYSDOH*****FI*141797357~PER*IC*EMEDNY PROVIDER SERVICES*TE*8003439000*UR*www.emedny.org~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~HL*3*2*22*0~TRN*2*202608122005000001*00000000ND~NM1*IL*1*VALDEZSURIEL*JORGE*R***MI*ZF85153E~N3*560      45TH STREET          1~N4*BROOKLYN*NY*11220~DMG*D8*19380423*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260701~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*ELDERPLAN INC HOMEFIRST PARTIAL LTC*****PI*ED~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8777711119~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H4868~LS*2120~NM1*P4*2*WELLCARE*****PI*H4868~N3*PO BOX 25885~N4*TAMPA*FL*33622~PER*IC*PROVIDER SERVICES*TE*8002785155~LE*2120~EB*R*IND*30~REF*18*1E63P17FE80~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*533841530~GE*1*533841530~IEA*1*533841530~